Fortify Middle Ground With National Postgraduate Medical Curriculum — Dr Musa Mohd Nordin, Prof Dr Azizi Omar, Prof Dr Zulkifli Ismail, Prof Dr Wan Ariffin Abdullah & Dr Tan Hui Siu

Five paediatricians urge a middle ground on the parallel pathway conflict, citing the National Postgraduate Medical Curriculum (NPMC). “This present impasse does not need to be a zero-sum game, as each training pathway has its strengths and weaknesses”.

YB Datuk Seri Dr Dzulkefly Ahmad
Minister of Health

Dear Dr Dzul,

As five paediatricians, we humbly begin with the concluding aspiration of our earlier article, that the voice of reason and rationality should take precedence over the polarity of positions between the Parallel Pathway and the Master’s medical specialty training programmes. We should all be part of the solution, not the problem.

To put it mildly, the haram fatwa by a non-medical, former vice chancellor of a local university is incongruous and unhelpful. Simply put, this is part of the problem.

In one’s moral anger and hostility, “You don’t throw the baby out with the bathwater” or in the Malay proverb “Jangan marahkan nyamuk, kelambu dibakar” (Because of anger at the mosquitoes, the mosquito nets are burned).

The nation’s interest is the priority, and it is now at a critical juncture. Any roadmap to the national medical specialty training must minimise harm – “first do no harm” – and maintain the continuity of the current health care and service provisions.

It must also embrace distributive and procedural justice, be socially and politically egalitarian, and produce quality medical specialists efficiently and productively. All processes should be transparent and accountable, with proper oversight.

The toxic media exchanges between the proponents of either pathway have shed some historical and contemporary perspectives. However, they are also loaded with their respective bias and innuendos and are equally problematic.

The feuds completely missed the evolution of several excellent programmes, of which the exponential trajectory has been heading towards a unified and structured training module for our medical postgraduates.

The 12 specialties include:

  1. Clinical Oncology
  2. Emergency Medicine
  3. General Surgery
  4. Internal Medicine
  5. Obstetrics & Gynaecology
  6. Orthopaedic Surgery
  7. Paediatrics
  8. Primary Care Medicine
  9. Psychiatry
  10. Radiology
  11. Rehabilitation Medicine
  12. Anaesthesiology and Critical Care Medicine

The pioneering efforts of our trainers, mentors and scholars in the Ministry of Health (MOH), Ministry of Higher Education (MOHE), Medical Deans Council, Specialty/Conjoint Boards, Academy of Medicine Malaysia (representing medical professional societies and the private health care sector) et al have culminated in the milestone launch of the National Postgraduate Medical Curriculum (NPMC) on 27th August 2021 and must not be dismissed.

The unification efforts kick started around 2012. While some chose to squabble and oppose another training pathway, many of our senior clinicians and educators decided to cast aside their training pathways and professional differences. They prioritised their obligations to the nation and developed the NPMC.

So, with these historical and present contexts as the bigger picture of our nation’s postgraduate medical education journey, we ask that you as the Minister of Health, with careful and thoughtful deliberations seeking all voices, consider the following suggestions:

It would be virtually impossible to halt opposing positions and emotions from the hardliners of both camps. The best way is to fortify the middle ground, as in the “Madani” vision, to uphold the just culture of the “ummatan wasata”, “And so We have made you the middle nation …” (Quran 2:143).

This present impasse does not need to be a zero-sum game, as each training pathway has its strengths and weaknesses.

It’s heartwarming to know there will be a strengthening of the training and recognition of medical specialists through the amendments of the law to increase the specialist numbers to serve the rakyat.

Our health care ecosystem must be led by well-trained specialists who use evidence-based medicine and best practices. Any amendments to the law must include the voices of these specialists who serve the rakyat on the ground, not just academics or lawyers.

Please consider the input of the medical advisors, contributors, and reviewers of the 12 NPMCs, who have demonstrated collectively that it is possible to involve all relevant stakeholders in the postgraduate training to develop a standard curriculum. Actually, more specialties are on their way as well for an NPMC.

As in our previous article, the twelve NPMCs have clearly addressed the three stringent issues of a central registry of training centers and entry criteria, a structured curriculum, and exit criteria.

We hope the Ministry will adopt the NPMC protocol as the precursor to our own Malaysian Royal College of Paediatrics/ Medicine or the Malaysian Masters of Paediatrics/ Medicine, for example.

After 67 years of independence, we could finally express our gratitude to our teachers in the UK, Ireland, Australia, and New Zealand, and to quote Frank Sinatra: “The record shows I took the blows. And I did it my way.”

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